Provider Demographics
NPI:1699664664
Name:TERRA, MICHON (RN BSN)
Entity type:Individual
Prefix:
First Name:MICHON
Middle Name:
Last Name:TERRA
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 OMELIA RD
Mailing Address - Street 2:
Mailing Address - City:BROAD BROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06016-9731
Mailing Address - Country:US
Mailing Address - Phone:860-216-8414
Mailing Address - Fax:
Practice Address - Street 1:25 OMELIA RD
Practice Address - Street 2:
Practice Address - City:BROAD BROOK
Practice Address - State:CT
Practice Address - Zip Code:06016-9731
Practice Address - Country:US
Practice Address - Phone:860-216-8414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT214061163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice